Provider Demographics
NPI:1669637013
Name:PATEL, MAYANK (MD)
Entity type:Individual
Prefix:DR
First Name:MAYANK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 845996
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5996
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-221-5036
Practice Address - Street 1:18321 VENTURA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4253
Practice Address - Country:US
Practice Address - Phone:818-776-0660
Practice Address - Fax:818-776-8620
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA103731208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology